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Table of Contents
CASE REPORT
Year : 2011  |  Volume : 3  |  Issue : 2  |  Page : 108-109  

Iatrogenic neonatal bladder perforation


1 Department of Neonatology, Hedi Chaker Hospital, Sfax, Tunisia
2 Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
3 Department of Radiology, Hedi Chaker Hospital, Sfax, Tunisia

Date of Submission29-Jun-2010
Date of Acceptance10-Aug-2010
Date of Web Publication17-Jun-2011

Correspondence Address:
Mohamed Jallouli
Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax - 3029
Tunisia
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DOI: 10.4103/0974-7796.82181

PMID: 21747605

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   Abstract 

Neonatal bladder rupture is rare as a complication of bladder obstruction due to abnormal anatomy or iatrogenic causes. The present study describes the case of a 3-day-old infant with ascites due to bladder perforation secondary probably to manual decompression of the bladder. The infant underwent successful surgical repair of the perforation.

Keywords: Bladder rupture, surgery, urinary ascites


How to cite this article:
Trigui L, Jallouli M, Hmida N, Mnif Z, Mhiri R, Gargouri A. Iatrogenic neonatal bladder perforation. Urol Ann 2011;3:108-9

How to cite this URL:
Trigui L, Jallouli M, Hmida N, Mnif Z, Mhiri R, Gargouri A. Iatrogenic neonatal bladder perforation. Urol Ann [serial online] 2011 [cited 2019 Sep 21];3:108-9. Available from: http://www.urologyannals.com/text.asp?2011/3/2/108/82181


   Introduction Top


Neonatal bladder rupture is rare as a complication of bladder obstruction due to abnormal anatomy or iatrogenic causes. The present study describes the case of 3-day old with ascites due to bladder perforation secondary probably to manual decompression of the bladder


   Case Report Top


A 2150 g female was born to a gravida 3, para 3, mother at 32 weeks' gestation with a low APGAR score. Respiratory distress syndrome developed requiring ventilatory assistance. Umbilical artery and vein catheterization was performed without any difficulties. On day 3, the child became oliguric with an increased abdominal girth and azotemia (blood urea 15 μmol/l and creatinine 129 μmol/l). Renal sonography demonstrated normal kidneys and bladder and ascites. Urethral bladder catheterization initially yielded a small volume of urine. Paracenthesis was done and the ascitic fluid was yellow. The biochemistry of the ascitic fluid confirmed the urinary origin. A cystogram revealed intraperitoneal extravasation. Exploration with a CT scan with bladder opacification was done to better specify the seat of the urinary leakage, and demonstrated a posterior perforation of the bladder [Figure 1]. Laparotomy was performed through a small transverse incision centered on the midline midway between the umbilicus and the pubic symphysis. Surgical exploration showed no uracheal injury with a posterior rugged perforation of the bladder (10Χ5 mm). The bladder was closed in two layers with an absorbable suture. Azotemia was corrected rapidly, and renal function returned to normal with a good urine output from the Foley catheter. Infant's condition improved, and the Foley catheter was removed on day 7, after performing a cystogram control.
Figure 1: CT scan with images of opacification of the bladder demonstrating extra-peritoneal extravasations of the infused contrast from the posterior aspect of the bladder

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Retrospectively, when we reviewed the medical record of the baby, an episode of urinary retention was observed at day 2 after birth. It was treated by manual decompression. This maneuver can explain the bladder perforation.


   Discussion Top


Rupture of the bladder is extremely rare in the newborns. It often develops as a complication of bladder obstruction, due to abnormal anatomy, or secondary to procedures such as umbilical catheterization. Urinary ascites can also result from the perforation of the bladder during urethral catheterization [1],[2] or from manual decompression of the bladder, [3] particularly in premature newborns.

Several cases have been described in children who are believed to be predisposed to such an event. These predisposing factors include bladder diverticula as congenital, [4] from a connective tissue disease such as  Ehlers-Danlos syndrome More Details, [5] from a neurogenic bladder dysfunction, [6] from a hypoxic event that was felt to lead to localized bladder wall ischemia, or from prematurity. [7] The rarity of bladder perforation in infants dictates the need for a high index of suspicion for a urological source in infants presenting with acute renal failure and a distended abdomen. Once bladder perforation is diagnosed, several authors advocate for aggressive management with an open repair. [8] However, conservative management with catheter drainage and broad-spectrum antibiotics has been proposed by some authors. [4],[7] In our case, since the etiologic cause of the bladder perforation was not possible on radiographic findings, surgical exploration was needed. We believe that surgery has two aims: on one hand, injury assessment and on the other minimizing the duration of urethral catheter drainage.

 
   References Top

1.O'Brien WJ, Ryckman FC. Catheter-induced urinary bladder rupture presenting with pneumoperitoneum. J Pediatr Surg 1994;29:1397-8.   Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Raupp P. Urethral catheterization in neonates--how far is too far? J Perinat Med 2002;30:440-1.   Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Salama H, AlJuFairi M, Rejjal A, al-Alaiyan S. Urinary bladder perforation in a very low birth weight infant. A case report. J Perinat Med 2002;30:188-91.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Stein RJ, Matoka DJ, Noh PH, Docimo SG. Spontaneous perforation of congenital bladder diverticulum. Urology 2005;66:881.  Back to cited text no. 4
    
5.Jorion JL, Michel M. Spontaneous rupture of bladder diverticula in a girl with Ehlers-Danlos syndrome. J Pediatr Surg 1999;34:483-4.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Briggs JR, Minns RA, Smith II. Congenital rupture of a neuropathic bladder: report of a case. Dev Med Child Neurol 1985;27:369-74.  Back to cited text no. 6
[PUBMED]    
7.Vasdev N, Coulthard MG, De la hunt MN, Starzyk B, Ognjanovic M, Willetts IE. Neonatal urinary ascites secondary to urinary bladder rupture. J Pediatr Urol 2009;5:100-4.  Back to cited text no. 7
    
8.Tran H, Nguyen N, Nguyen T. Neonatal bladder rupture. Indian J Pediatr 2009;76:427-9.  Back to cited text no. 8
[PUBMED]  [FULLTEXT]  


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